158 articles - From Friday May 05 2023 to Friday May 12 2023
Guidelines and related publications, position statements, white papers, technical reviews, consensus statements, etc…
| J Crohns Colitis |
DECIDE: Delphi Expert Consensus Statement on Inflammatory Bowel Disease Dysplasia Shared Management Decision-Making. By consolidating evidence for best practice using literature review, key stakeholder and decision-making expert consultation we have developed international consensus recommendations to support healthcare professionals counselling patients on the management of high cancer risk colitis-associated dysplasia. The final toolkit includes clinician and patient decision aids to facilitate shared decision-making. |
| Liver Transpl |
meta-analyses and systematic reviews
| Liver Transpl |
Type of donor liver transplant does not affect pregnancy outcomes - a systematic review and meta-analysis. The results suggest that pregnancy outcomes after LDLT and DDLT are comparable. Despite LDLT being statistically significantly associated with a higher rate of stillbirths, the association is weak and is unlikely to be clinically significant. |
RCT, clinical trials, retrospective studies, etc…
| Am J Clin Nutr |
Appraising the associations between systemic iron status and epigenetic clocks: A genetic correlation and bidirectional Mendelian Randomization study. All four iron status biomarkers had a significant or suggestively significant causal effect on epigenetic clocks, whereas reverse MR studies did not. |
Association of protein intake with recurrence and survival following primary treatment of ovarian cancer. After primary treatment for ovarian cancer, a higher level of protein intake may benefit progression-free survival. Ovarian cancer survivors should avoid dietary practices that limit intake of protein-rich foods. |
Associations of Midlife Dietary Patterns with Incident Dementia and Brain Structure: Findings from the UK Biobank Study. Greater adherence to hPDI, MDS, RFS, and MIND was individually associated with larger brain volumes in specific regions. This study shows a comprehensive picture of the consistent associations of midlife dietary patterns with the risk of dementia and brain health, underscoring the potential benefits of a healthy diet in the prevention of dementia. |
Best (but oft forgotten) statistical practices: Measuring real-world intervention effectiveness using electronic health data. However, real-world intervention effectiveness studies using electronic health data face many challenges including data quality, selection bias, confounding by indication, and lack of generalizability. In this article, we describe the key barriers to generating high-quality evidence from real-world intervention effectiveness studies and suggest statistical best practices for addressing them. |
Comparing the effects of consuming almonds or biscuits on body weight in habitual snackers: A one-year randomized controlled trial. Almonds can be incorporated into the diets of habitual snackers to improve diet quality, without evidence for changes in body weight, compared to a popular discretionary snack food. |
Development of iron status measures during youth: associations with sex, neighborhood socioeconomic status, cognitive performance, and brain structure. Iron status evolves during youth and is lowest in females and individuals of low SES during adolescence. Diminished iron status during adolescence has consequences neurocognition, suggesting that this critical period of neurodevelopment may be an important window for intervention that has the potential to reduce health disparities in at-risk populations. |
Dietary micronutrient adequacy and risk of multimorbidity in community-dwelling older adults. A higher micronutrient index score was associated with lower risk of multimorbidity. Improving the dietary micronutrient adequacy could prevent multimorbidity among older adults. Clinical trial registry ClinicalTrials.gov NCT03541135. |
Dietary Polyphenol Intake and Risk of Hypertension: An 18-year Nationwide Cohort Study in China. This study demonstrated an inverse and nonlinear association between dietary polyphenol, especially lignan and stilbene, and hypertension risk. The findings provide implications for hypertension prevention. |
The Neurobiology of Eating Behavior in Obesity: Mechanisms and Therapeutic Targets: a Report from the 23rd Annual Harvard Nutrition Obesity Symposium. The purpose of this article is to summarize the key findings presented in June 2022 at the 23 rd annual Harvard Nutrition Obesity Symposium entitled "The Neurobiology of Eating Behavior in Obesity: Mechanisms and Therapeutic Targets". Findings presented at the symposium, sponsored by NIH P30 Nutrition Obesity Research Center at Harvard, enhance our current understanding of appetite biology, including innovative techniques used to assess and systematically manipulate critical hedonic processes, which will shape future research and the development of therapeutics for obesity prevention and treatment. |
| Inflamm Bowel Dis |
Higher Ustekinumab Levels in Maintenance Therapy are Associated with Greater Mucosal Healing and Mucosal Response in Crohn's Disease: An Experience of 2 IBD Centers. This study demonstrates that higher ustekinumab serum trough levels are associated with a greater likelihood of achieving mucosal healing and mucosal response in patients with Crohn's disease regardless of prior biologic exposure. Further prospective studies are required to correlate target maintenance trough levels and the optimal time to dose-escalate in order to improve patient outcomes. |
Impact of Vedolizumab on Extraintestinal Manifestations in Inflammatory Bowel Disease: Results From a Descriptive, Retrospective, Real-world Study. This real-world study showed resolution of al EIMs in up to one-fourth of patients with IBD and improvement in up to half of EIMs within 12 months of vedolizumab treatment. Overall, vedolizumab was effective on EIMs in patients with IBD and showed a good safety profile. |
| J Crohns Colitis |
Assessment of Stool DNA Markers to Detect Colorectal Neoplasia in Patients with Inflammatory Bowel Disease: A Multi-site Case-control Study. These data highlight the potential of multitarget stool-DNA marker testing as an important addition to colorectal cancer surveillance by complementing colonoscopic evaluations in inflammatory bowel disease patients. |
Distinct alterations in central pain processing of visceral and somatic pain in quiescent ulcerative colitis compared to irritable bowel syndrome and health. When confronted with acute pain from multiple bodily sites, UC patients' responses are distinctly altered. Their failure to prioritize pain arising from the viscera may reflect a lack of adaptive behavioral flexibility possibly resulting from long-lasting central effects of repeated intestinal inflammatory insults persisting during remission. The role of psychological factors, particularly chronic stress, in visceral sensitivity and disease-specific alterations in the response to acute pain call for dedicated mechanistic research as a basis for tailoring interventions for intestinal and extraintestinal pain symptoms in IBD. |
Female and Male Fertility after Colectomy and Reconstructive Surgery in Inflammatory Bowel Diesase: A National Cohort Study from Sweden. Fertility was reduced in women after colectomy for IBD. The least impact was seen when a deviated rectum was left intact. IRA was associated with no further reduction in fertility, whereas proctectomy and IPAA were associated with the strongest impairment. IRA therefore seems to be the preferred reconstruction to preserve fertility in selected female patients. Fertility in men was only moderately reduced after colectomy. |
| Liver Transpl |
AFP-L3 and DCP are superior to AFP in predicting waitlist dropout in hepatocellular carcinoma patients: results of a prospective study. Kaplan-Meier probability of waitlist dropout within 2 years was 21.8% in those with AFP-L3 < 35% and DCP < 7.5 ng/mL, 59.9% with either AFP-L3 or DCP elevated, and 100% for those with both elevated (p < 0.001). In this prospective study, listing AFP-L3% and DCP were superior to AFP in predicting waitlist dropout with the combination of AFP-L3 = 35% and DCP = 7.5 ng/mL associated with a 100% risk of waitlist dropout, thus clearly adding prognostic value to AFP alone. |
Anatomical classification and clinical outcomes of biliary strictures in living donor liver transplantation using right liver grafts. IHBSs are relatively common in right liver LDLTs. Although Type 3 IHBSs are rare, they require more intensive care and are associated with poorer graft survival rates than anastomosis strictures and Type 2 IHBS. |
Biliary Reconstruction in Adult Living Donor Liver Transplantation: The All-Knots-Outside Technique. In the multivariate analysis, the number of bile ducts (hazard ratio [HR], 4.18; 95% confidence interval [CI], 1.62-10.78; P = 0.003), number of anastomoses (HR, 2.03; 95% CI, 1.03-4.02; P = 0.04), and technique of anastomosis (HR, 0.36; 95% CI, 0.19-0.68; P = 0.002) predicted BCs. In conclusion, in adult LDLT, with standardization of the donor and recipient surgery, preferential use of LHA for right lobe arterial reconstruction, reduction in the number of anastomoses, and AKOT for BR significantly decreased the incidence of BCs. |
Bilioenteric Reconstruction Techniques in Pediatric Living Donor Liver Transplantation. The results show that the DD reconstruction technique can achieve similar outcomes when compared with RY anastomosis. Because DD reconstruction is a more physiological way of establishing bilioenteric integrity, it can safely be applied. |
Combined liver transplantation and sleeve gastrectomy: Report of a brief-interval staged approach. This proof-of-concept study revealed that a brief-interval SG during LT is feasible in patients with high MELD and resulted in sustained weight loss at 1 year with similar graft survival. Further studies are needed to determine an optimal strategy. |
Complex Liver Transplantation Using Venovenous Bypass With an Atypical Placement of the Portal Vein Cannula. In both patients, the decompression of the portomesenteric compartment was crucial to reduce portal hypertension and to access the hepatic hilum, where the dissection was very complex due to previous major surgeries. In conclusion, VVB with the interposition of a venous graft attached to the IMV or to the SV during LT is a safe and simple technique, and it may be useful for patients needing VVB with no standard access to the portal compartment, particularly in the case of severe portal hypertension and re-LTs. |
Dextroplantation of Left Liver Graft in Infants. Dextroplantation of a vLLS graft, even a large-for-size one, was successful in small infants without compromising venous outcomes, compared with conventional vLLS transplantation. We could remove the surgical drains earlier and reduce hospital stays in cases of dextroplantation. |
Early allograft dysfunction after living donor liver transplantation-current concepts and future directions. Thus, in this review, we present an overview of EAD after LDLT and have attempted to present balanced points of view on al its aspects, such as definitions, pathogenesis, risk factors, predictive markers, and management. The review aims to broadly overview the nature and extent of ongoing research evidence on this complex topic and inform practice in the field by identifying key concepts and knowledge gaps and highlighting areas that require further inquiry. |
Early neurologic complications post liver transplant are associated with reduced long-term survival and increased rates of rejection. Among 521 LT recipients, 24% experienced post-LT NC. Overall and rejection-free survival at 5-years was, respectively: 69% and 75% among those with NC versus 87% and 88% among those without NC (log-rank 125 and limiting perioperative |
Evaluation of liver stiffness measurement–based scores in liver transplantation recipients. The LSM-based scores did not improve the diagnostic performance of LSM alone in LT recipients for the detection of advanced fibrosis. This lack of improvement in diagnostic performance results from the impact of immunosuppression on bioclinical profile and underscores the importance of developing LSM-based scores that are specific to LT patients. |
Identifying Modifiable Predictors of Long-Term Survival in Liver Transplant Recipients With Diabetes Mellitus Using Machine Learning. Hypertension, decreased renal function, and sirolimus for maintenance immunosuppression compound this mortality risk. These predisposing factors must be intensively treated and modified to optimize long-term survival after transplant. |
Impact of Payer Status on Delisting Among Liver Transplant Candidates in the United States. In this study, LT candidates with Medicare or Medicaid had a 20% increased risk of delisting because of death or clinical deterioration compared with those with private insurance. As more patients use public insurance to cover the cost of LT, targeted waitlist management protocols may mitigate the increased risk of delisting in this population. |
Incorporating Tumor Biology to Predict Hepatocellular Carcinoma Recurrence in Patients Undergoing Living Donor Liver Transplantation Using Expanded Selection Criteria. Acceptable long-term outcomes were achieved using our expanded selection criteria. Our prognostic model to predict recurrence based on preoperative biological and morphological factors could guide pretransplant management (downstaging versus upfront LDLT) with the aim of reducing post-LDLT recurrence. |
Introducing EL-FIT (Exercise and Liver FITness): A Smartphone App to Prehabilitate and Monitor Liver Transplant Candidates. We showed that patients with ESLD are able to use and interact with the EL-FIT app. This novel smartphone app has the potential of becoming an invaluable tool for home-based prehabilitation in LT candidates. |
Liver Transplantation Using Hepatitis C Virus-Viremic Donors Into Hepatitis C Virus-Aviremic Recipients as Standard of Care. No patients had evidence of fibrosing cholestatic hepatitis or extrahepatic manifestations of HCV. This report indicates that transplantation of DNAT+ livers into rHCV- and subsequent DAA therapy is associated with clinical outcomes comparable to those achieved with DNAT- allografts. |
Long-Term Safety and Efficacy of Pure Laparoscopic Donor Hepatectomy in Pediatric Living Donor Liver Transplantation. In addition, the laparoscopic approach for the donors did not adversely affect the corresponding recipient's outcome. Laparoscopic left lateral sectionectomy for living donors is a safe, feasible, and reproducible procedure for pediatric liver transplantation. |
Longterm Outcome of Liver Transplantation for Congenital Extrahepatic Portosystemic Shunt. A total of 25 (96%) patients in our survey and 26 (90%) patients in the literature review were alive with a median follow-up period of 9.5 and 1.6 years, respectively. Although LT has a limited role in management of CEPS, our study indicated that LT was safe as an alternative treatment for select patients with malignant tumor or pulmonary complications and those with complications related to new portosystemic collateral vessels after shunt closure, such as PH or hepatopulmonary syndrome. |
Machine learning improves the accuracy of graft weight prediction in living donor liver transplantation. Machine learning can improve the precision of GW estimation compared with currently available methods by reducing the frequency of significant errors. The coupling of anthropometric variables to the preoperatively estimated graft volume seems necessary to improve the accuracy of GW estimation. |
Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease exception policy and outcomes in pediatric patients with hepatopulmonary syndrome requiring liver transplantation. These data suggest that adult criteria for granting MELD/PELD exception points may not appropriately capture HPS severity in pediatric patients. Further prospective multicenter studies to examine the risk factors predicting negative survival outcomes in children with HPS are warranted. |
Multicenter, Double-Blind, Randomized Trial of Emricasan in Hepatitis C-Treated Liver Transplant Recipients With Residual Fibrosis or Cirrhosis. In conclusion, overall stability in the Ishak fibrosis stage was similar between emricasan and placebo groups at 24 months. However, there was improvement and/or stability in fibrosis stage in the prespecified F3 to F5 subgroup with emricasan versus placebo, suggesting that patients with moderate fibrosis may benefit with emricasan. |
National Trends in Location of Death in Patients With End-Stage Liver Disease. Deaths in patients with ESLD are increasingly common at hospice and home overall, and although the rates have been increasing among Black patients, they are still less likely to die at hospice or home. Efforts to improve this disparity, promote end-of-life care planning, and enhance access to death at hospice and home are needed. |
Outcomes of patients with acute liver failure listed for liver transplantation: A multicenter prospective cohort analysis. Post-LT outcomes for ALF are excellent in this cohort of very ill patients. The development of multiorgan failure while on the transplantation list and APAP ALF etiology were associated with a lower likelihood of successful receipt of LT. |
Practice patterns of the medical evaluation of living liver donors in the United States. At most centers, the need for cardiovascular ischemic risk testing is based on age (73.6%) and the presence of one or more cardiac risk factors (68.0%). Defining areas of practice consensus and variation underscores the need for data generation to develop evidence-based guidance for the evaluation and risk assessment of living liver donors. |
Reduced metabolic flexibility is a predictor of weight gain among liver transplant recipients. Inefficient transition between biofuels (carbohydrates and fatty acids) is associated with weight gain in LT recipients that is independent of clinical metabolic risk. These data offer novel insight into the physiology of obesity post-LT with potential to develop new diagnostics and therapeutics. |
Regulatory T Cell Therapy Following Liver Transplantation. We then review the preclinical data supporting their production, mechanism of action, and therapeutic efficacy followed by a summary of relevant clinical trials. Finally, we discuss the outstanding challenges of Treg therapy and its future prospects for routine use in LT. |
Sequential Protocol Biopsies Post-Liver Transplant From Donors With Moderate Macrosteatosis: What Happens to the Fat? Despite these encouraging findings, the perioperative risks of using these livers (postreperfusion cardiac arrest and primary nonfunction) should not be understated. Long-term graft survival is acceptable in patients who are able to overcome the immediate perioperative risk of using moderately steatotic donor livers. |
The Organ Procurement and Transplantation Network hepatocellular carcinoma classification: Alignment with Liver Imaging Reporting and Data System, current gaps, and future direction. However, despite this significant milestone, the OPTN allocation policy may benefit from further refinements such as adoption of treatment response assessment criteria after locoregional therapy and categorization criteria for lesions with atypical imaging appearances that are not specific for HCC. In this review, we detail the changes to the OPTN HCC classification to achieve alignment with LI-RADS, discuss current limitations of the OPTN classification, and explore future directions. |
The Predictive Role of Model for End-Stage Liver Disease-Lactate and Lactate Clearance for In-Hospital Mortality Among a National Cirrhosis Cohort. MELD-lactate had significantly superior performance in predicting in-hospital mortality among patients hospitalized for infection and/or with MELD =15 when compared with MELD or MELD-Na. Incorporating day 3 lactate clearance may further improve prognostication. |
Understanding the Final Disposition of Livers Declined After the Start of Procurement: A Nationwide Organ Procurement Organization Effort. Expedited allocation was more time consuming than allocation into a predetermined backup. Although a certain number of intraoperative declines probably suggests a healthy amount of donor selection aggressiveness at the time of the initial organ offer, the 47% risk of discard of livers declined intraoperatively suggests that United Network for Organ Sharing should consider systematically collecting data about intraoperative declines so we can learn more about this event that influences organ utilization. |
Variation in Racial Disparities in Liver Transplant Outcomes Across Transplant Centers in the United States. This is the first study to directly evaluate the role transplant centers play in racial disparities in transplant outcomes. Further assessment of the qualitative factors that may drive disparities, such as selection processes and follow-up care, is needed to create effective center-level interventions to address health inequity. |
Viability assessment and transplantation of fatty liver grafts using end-ischemic normothermic machine perfusion. Overall, NMP allowed successful transplantation of 57% of livers with moderate-to-severe MaS. Our findings suggest that prolonged observation (=6 h) might be required for steatotic livers and that stable lactate clearance is a fundamental prerequisite for their use. |
Waitlist and posttransplantation outcomes of lean individuals with nonalcoholic fatty liver disease. Patients with NAFLD with normal weight have increased waitlist removal and those who remained at normal weight during the waitlist period have worse posttransplantation outcomes. Identifying and addressing factors influencing apparent healthy weight prior to LT are crucial to mitigate poor outcomes. |
Waitlist mortality of young patients with biliary atresia: Impact of allocation policy and living donor liver transplantation. Since 2014, waitlist mortality in young patients with BA has strongly decreased in the ET region. Rather than associated with prioritized allocation of deceased donor organs, the decreased waitlist mortality was related to a higher proportion of patients undergoing LDLT. |
| Pancreas |
| Pancreatology |
Endoscopic ultrasound fine-needle biopsy to assess DAXX/ATRX expression and alternative lengthening of telomeres status in non-functional pancreatic neuroendocrine tumors. DAXX/ATRX expression and ALT status can be accurately evaluated in a preoperative setting on EUS-FNB samples, potentially improving the identification of patients with increased risk and poorer prognosis. |
Inhibition of mouse trypsin isoforms by SPINK1 and effect of human pancreatitis-associated mutations. Human SPINK1 and its mouse ortholog inhibited mouse trypsins with comparable efficiency (K 60 nM and 47.5 pM, respectively), whereas mutations D35S (human N34S) and A56S (human P55S) had no impact on trypsin inhibition. Our results confirmed that high-affinity trypsin inhibition by SPINK1 is conserved in the mouse, and the functional consequences of human pancreatitis-associated SPINK1 mutations can be replicated in the mouse inhibitor. |
Plenty of the editorials are available as full text through the publisher website using the provided link
| Am J Clin Nutr |
misc publications eg case reports, tools of the trade, images of the month, etc…
| Inflamm Bowel Dis |
| Liver Transpl |
Letters to the editors and authors’ replies